ACL Reconstruction

Guide to ACL Reconstruction Surgery in Michigan

These articles are for general information only and are not medical advice. Full Disclaimer. All articles are compliments of the AAOS

When you twist or fall on your knee, you can tear a stabilizing ligament that connects your thigh bone to the shin bone. An anterior cruciate ligament (ACL) unravels like a braided rope when it’s torn and does not heal on its own. If you've suffered an ACL tear, you may require surgery to regain knee stability for sports and daily activities. Fortunately, ACL reconstruction surgery can help many people recover their full function after an ACL tear. Here’s what you can expect with ACL reconstruction, from injury to recovery.

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What Causes a Torn Knee Ligament?

Ligaments are tough, non-stretchable fibers that hold your bones together. The cruciate ligaments in your knee joints crisscross to give you stability on your feet, with the anterior cruciate ligament (ACL) being one of the joint’s main stabilizing structures. It prevents excessive forward sliding of the tibia and helps pivot smoothly.

People often tear the ACL by changing direction rapidly, slowing down from running, or landing from a jump. Young people (age 15-25) who participate in basketball and other sports that require pivoting are especially vulnerable. You may hear a "pop" at the time of injury as the ligament ruptures. Your knee gives out and soon begins to hurt and swell.

How ACL Tears Are Diagnosed

The sports medicine surgeons at Mendelson Kornblum Orthopedics (MKO) rely on physical examination and MRI scans to evaluate ACL tears. We apply manual testing, looking for increased forward shifting of the tibia bone - called the Lachman and anterior drawer tests. Comparison to the uninjured opposite knee helps confirm unstable motion, indicating a tear. MRIs visualize the status of the ACL fibers as well as surrounding structures. 

 

Your doctor may conduct physical tests and take X-rays to determine the extent of damage to your ACL. Most of the time, you need reconstruction surgery. Your doctor replaces the damaged ACL with strong, healthy tissue taken from another area near your knee. A strip of tendon from under your kneecap (patellar tendon) or hamstring may be used. Your doctor threads the tissue through the inside of your knee joint and secures the ends to your thigh bone and shinbone.

 

In a few cases when the ACL is torn cleanly from the bone it can be repaired. Less active people may be treated non-surgically with a program of muscle strengthening.

Common ACL Injury Symptoms

Torn ACL symptoms may include:

  • Hearing or feeling a "pop" in the knee at the time of injury.
  • Instability in the knee or it "giving out" during activities.
  • Pain and swelling in the knee, sometimes severe at first but often subsiding over a few days.
  • Tenderness concentrated directly along the joint line.
  • The knee "catching" or not moving smoothly through the full range of motion.
  • Feeling as if the shin bone is shifting forward abnormally compared to the thigh bone.
  • A positive "Lachman test" showing excess forward translation of the tibia.
  • Inability to pivot or cut without pain or instability in the knee joint.
  • Difficulty bearing full weight through the torn ACL leg without it feeling unstable.
  • Stiffness and discomfort walking down hills or stairs.
  • Persistent limping caused by the knee not stabilizing adequately.

The first approach to treatment includes rest, ice compression, and elevation (RICE) plus a brace to immobilize the knee, crutches, and pain relievers. When these measures fail to alleviate pain, ACL repair surgery can help.

ACL Reconstruction Surgery Overview

The ACL cannot adequately heal itself once damaged, leaving the knee feeling unstable and prone to "giving out." Therefore, surgery replaces the torn ACL with a durable, new graft to reestablish firm stability. Successful ACL reconstruction surgery tightens your knee and restores its stability. It also helps you avoid further injury and get back to playing sports.

 

There are various ACL reconstruction techniques. The choice technique depends on various factors, including a patient's age, activity level, graft availability, and surgeon preference. Our orthopedic surgeons carefully evaluate each case to determine the most suitable approach, with the primary goal of restoring knee stability and function. Patients considering ACL reconstruction should consult their orthopedic surgeon to discuss the most appropriate technique for their circumstances.

Common ACL reconstruction techniques include:

Patellar Tendon Autograft

In this technique, a portion of the patellar tendon, along with a piece of bone from the patella and tibia, is used to replace the damaged ACL. This is a popular choice due to its strength and relatively straightforward surgical procedure.

Hamstring Tendon Autograft

The surgeon harvests tendons from the patient's hamstring muscles to create a graft for ACL reconstruction. This technique is known for reduced pain and quicker recovery than patellar tendon autografts.

Allografts

Allografts involve using donor tissue, often taken from cadavers, to reconstruct the ACL. While allografts eliminate the need to harvest the patient's tissue, they may have longer graft incorporation times and a slightly higher risk of infection.

Double-Bundle Technique

This technique involves reconstructing the anteromedial and posterolateral bundles of the ACL, aiming to better replicate the natural anatomy of the ligament.

Anatomic Reconstruction

Surgeons may opt for an anatomic approach, aiming to recreate the ACL as closely as possible to its natural anatomy. This technique considers the individual variations in patient anatomy to provide a more personalized and natural-feeling reconstruction.

All-Inside Technique

In recent years, advancements in arthroscopic surgery have led to the development of all-inside ACL reconstruction techniques. These procedures involve smaller incisions and may result in less postoperative pain and quicker recovery.

What to Expect With ACL Surgery Recovery

The initial postoperative phase following ACL reconstruction surgery focuses on safely recovering while protecting graft integration. Icing and gradual range of motion are important early on. Using crutches prevents falling as strength returns.

 

After ACL reconstruction, you’ll need to do orthopedic rehabilitation exercises to gradually return your knee to full flexibility and stability. Our team closely monitors your progress through defined rehab timeframes based on the reconstruction technique used. Building strength in your thigh and calf muscles helps support the reconstructed structure. You may need to use a knee brace for a while and will probably have to stay out of sports for about one year after the surgery.

ACL reconstruction surgery reliably restores knee stability so you can be confidently active again without limitations. Reach out with any questions on treating torn knee ligaments or schedule a consultation.